UNDIAGNOSED HEMORRHAGIC FEVER - INDIA: (MAHARASHTRA)

*What is interesting about this case, is that the victim was a vegetarian who did not frequent livestock markets,..the "normal" source of infection...but it is suggested (below) that the vector MAY have come from an aerosol spray
???????????????????????

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International Society for Infectious Diseases

Date: Sat 22 Jan 2011
Source: DNA (Daily News Analysis) [edited]

Viral haemorrhagic fever in Mumbai
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Days after 3 cases of Crimean-Congo hemorrhagic fever (CCHF) were
detected in Ahmedabad, a 48-year-old resident of Thane [a city to the
north of Mumbai] has shown clinical symptoms of [a] viral
haemorrhagic fever and is critical. Doctors at Jaslok Hospital where
the patient was referred to earlier transferred him to the BMC
[Brihanmumbai Municipal Corporation]-run Kasturba hospital on Friday
morning [21 Jan 2011].

The disease has so far claimed 3 lives in Ahmedabad in the last few
days and has resulted in health authorities screening thousands of
people. The mortality rate from CCHF is approximately 90 percent, say
doctors, with death occurring in the 2nd week of illness.

Consulting physician at Jaslok, Dr Pratik Samdhani told DNA, "Sampat
was referred to me last night. He had high fever and was disoriented.
He was not responding to the treatment given by the local physician
for 6-7 days. His MRI scan revealed that he was bleeding in the
brain. Besides, he has a low blood platelets count. His kidney and
liver were deranged." The patient, whose dengue, malaria and
leptospirosis tests were negative, is on ventilator.

"Since patients with CCHF have already been detected in Ahmedabad and
the disease is infectious, the patient needed to be kept under 4th
degree of isolation. Since Jaslok [hospital] does not have this
facility, we decided to shift him to Kasturba Hospital," explained
Samdhani. "There is no improvement in his condition."

The patient is a vegetarian and had no contact with livestock. His
last visit outside the city was to Shirdi some days ago. "We have
recommended Kasturba to give him Ribavirine," Samdhani said.

Jaslok Hospital also gave the medication to 47 of its employees,
including Dr Samdhani, as a precautionary measure.

"Jaslok has also instructed Kasturba Hospital to send secretion
samples to the National Institute of Virology (NIV). This includes
nasal swab and sputum," said Dr Samdhani. Samdhani said the the viral
infection could either be arboviral or adenoviral [i.e., presumably
insect or aerosol aerosol transmitted, as opposed to tick-transmitted?].

Dr GT Ambe, executive health officer, BMC, said he is not aware about
the development. Doctors say that the disease is fatal. Unless it is
detected at an early stage, and treated aggressively, the patient
dies immediately after.

CCHF was successfully identified by the NIV few days ago. The disease
is endemic in many countries in Africa, Europe and Asia. In 2001,
cases or outbreaks were recorded in Kosovo, Albania, Iran, Pakistan,
and South Africa, according to WHO.

Doctors said after the virus strikes the patient, there is a
breakdown of blood and blood products. The tissues get damaged.
Thereafter one gets fever and develops a rash that leads to bleeding.
It can rapidly deteriorate to headaches, seizures, convulsions and
eventually lead to coma. The patient may also experience
irritability, and photophobia (irritation to light).

[Byline: Menaka Rao]

--
Communicated by:
Ronan Kelly

[Crimean-Congo haemorrhagic fever (CCHF) is primarily a zoonosis.
Sporadic cases and outbreaks of CCHF affecting humans do occur.
Humans who become infected with CCHF acquire the virus from direct
contact with blood or other infected tissues from livestock during
this time, or they may become infected from a tick bite. The majority
of cases have occurred in those involved with the livestock industry,
such as agricultural workers, slaughterhouse workers and
veterinarians. A detailed account of CCHF can found at the WHO website:
).

In the case of the patient in a Mumbai hospital the diagnosis has
been made mainly by association with a confirmed outbreak of CCHF in
Ahmedabad (in the state of Gujarat), far to the north of Mumbai (in
the state of Maharashtra). The observation that the patient is a city
dweller and a vegetarian is not compatible with the diagnosis of
CCHF. No positive diagnosis of the etiologic agent is reported but
dengue, malaria and leptospirosis infections have been excluded.
Curiously arboviral or adenoviral infection are being considered as
alternative diagnoses.

The results of the tests at the National Institute of Virology in
Pune (Maharashtra) are awaited.

A map of the states of India can be accessed at:
. The
HealthMap/ProMED-mail interactive map of India is available
at:
. - Mod.CP]

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